Citation Nr: 21026604 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 12-24 775 DATE: May 3, 2021 ORDER A disability rating in excess of 30 percent for ureterolithiasis with hematuria is denied. A 10 percent disability rating for hypertension, associated with ureterolithiasis, is granted. FINDINGS OF FACT 1. Ureterolithiasis with hematuria has neither been manifested by albuminuria nor a decrease in kidney function. 2. Hypertension, associated with ureterolithiasis, requires continuous medication for control. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 30 percent for ureterolithiasis with hematuria have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.115A, 4.115B, Diagnostic Code 7510. 2. The criteria for 10 percent disability rating for hypertension, associated with ureterolithiasis, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.104 Diagnostic Code 7101. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty from July 1977 to June 1980. These matters came to the Board of Veterans' Appeals (Board) on appeal from an April 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In a February 2018 decision, the Board, in pertinent part, denied entitlement to a 30 percent rating for ureterolithiasis with hematuria and hypertension. The Veteran filed a timely appeal with the United States Court of Appeals for Veterans Claims (Court). Pursuant to a January 2020 Joint Motion for Partial Remand (JMPR) and February 2020 Court Order, this portion of the Board decision was vacated and remanded for action consistent with the JMPR. Increased Ratings On October 31, 2011, the Veteran filed a claim for an increased disability rating. The Veteran's ureterolithiasis with hematuria and hypertension had been rated as 30 percent disabling under Diagnostic Code 7510, ureterolithiasis. In a September 2020 Supplemental Statement of the Case, a separate noncompensable rating was assigned to hypertension, associated with his ureterolithiasis. In a February 2021 rating decision, the hypertension rating was assigned effective October 31, 2011. Pursuant to Diagnostic Code 7510, ureterolithiasis is to be rated as hydronephrosis, except for recurrent stone formation requiring one or more of the following: 1) diet therapy; 2) drug therapy 3) invasive or non-invasive procedures more than two times/year. Pursuant to Diagnostic Code 7509, hydronephrosis, the highest assignable rating is 30 percent, and severe hydronephrosis is to be rated as renal dysfunction. Pursuant to 38 C.F.R. § 4.115A, renal dysfunction warrants a 60 percent rating for constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under diagnostic code 7101; an 80 percent rating is warranted for persistent edema and albuminuria with BUN 40 to 80mg%; or, creatinine 4 to 8 mg%; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion; and, a 100 percent rating is warranted requiring regular dialysis, or precluding more than sedentary activity from one of the following: persistent edema and albuminuria; or, BUN more than 80mg%; or, creatinine more than 8mg%; or, markedly decreased function of kidney or other organ systems, especially cardiovascular. The Veteran was afforded a VA contract medical examination in January 2012. His diastolic pressure was at most 80. The examiner opined that there was no history of diastolic pressure more than 100. There were no signs or symptoms due to renal dysfunction, including no albuminuria. The Veteran had frequent attacks of colic. The Veteran was afforded a VA medical examination in March 2016. The Veteran was diagnosed with renal dysfunction. However, the examiner stated that the Veteran did not have any signs or symptoms due to renal dysfunction. A July 2018 C&P examination reflects that the Veteran has undergone treatment recurrent stone formation in the urethra or bladder 0 to 1 times per year. He experienced dysuria, hematuria, and voiding dysfunction due to ureterolithiasis. He did not have a history of recurrent symptomatic bladder or urethral infections. The Veteran reported that he had been treated with lithotripsy on 3 separate occasions and was still passing stones. He complained of flank pain 4 to 5 times per year, which varies with a stone passing, and he complained of dysuria and hematuria. He did not have any renal dysfunction due to his ureterolithiasis. A March 2020 C&P examination reflects the Veteran's report that he most recently passed a stone in January 2019, and he was retrieving little pieces of stone 6 months later. He had been straining some and periodically sees blood in his urine. He experiences dysuria, hematuria, and voiding dysfunction due to ureterolithiasis. With regard to his recurrent stone formation, he uses diet therapy. He did not have any renal dysfunction due to his ureterolithiasis. With regard to diastolic pressure, VA treatment records show diastolic pressure of 95 in May 2013, 92 in June 2013, 87 in December 2013, 83 in July 2014, 72 in July 2016, 82 in March 2017, and 78 in April 2019. A January 2012 VA examination reflects diastolic pressure readings of 80 and 70, and that he took medication for his hypertension. A March 2016 VA examination reflects diastolic pressure of 90 at most and that he takes continuous medication to control his hypertension. A July 2017 private medical opinion from Dr. J.W.E. shows diastolic pressure of 84. A July 2018 C&P examination reflects diastolic pressure as 96, 92, and 94, and that he was taking continuous medication to control his hypertension. Without constant albuminuria with some edema, definite decrease in kidney function, or blood pressure readings showing a diastolic pressure predominantly 120 or more, the evidence of record is against a disability rating in excess of 30 percent for ureterolithiasis. There is no other rating criteria that could provide the basis for a rating in excess of 30 percent for ureterolithiasis. (Continued on the next page) While a noncompensable rating was assigned to hypertension, associated with ureterolithiasis, the Board finds that a 10 percent disability rating is warranted as the Veteran requires continuous medication for control of his hypertension. Such rating is assigned effective October 31, 2011, as it appears that he has required medication during the entire period contemplated by this appeal. A disability rating in excess of 10 percent is not warranted, as there is no showing of diastolic pressure predominantly 110 or more, nor systolic pressure predominantly 200 or more. Thus, a disability rating of 10 percent, but no higher, for hypertension associated with his ureterolithiasis, is granted based on the objective findings of record. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.W. Kreindler, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.